What life-threatening conditions are cirrhosis patients most at risk for?

From the Guidelines

Cirrhosis patients are most at risk for several life-threatening complications, including variceal bleeding, hepatic encephalopathy, spontaneous bacterial peritonitis, hepatorenal syndrome, and hepatocellular carcinoma, which can significantly impact morbidity, mortality, and quality of life. According to the most recent and highest quality study 1, these complications are a major cause of morbidity and mortality in cirrhosis patients. Variceal bleeding occurs when enlarged veins in the esophagus or stomach rupture due to portal hypertension, causing potentially fatal hemorrhage. Hepatic encephalopathy develops when the liver cannot remove toxins from the blood, leading to confusion, altered consciousness, and potentially coma. Spontaneous bacterial peritonitis is a serious infection of the ascitic fluid in the abdomen that can rapidly progress to sepsis. Hepatorenal syndrome involves progressive kidney failure due to altered circulation in advanced liver disease. Hepatocellular carcinoma (liver cancer) develops in many cirrhotic patients over time as ongoing inflammation and cell damage promote malignant transformation.

Some key points to consider:

• The incidence of varices in cirrhotic patients without varices at baseline is 5–9% at 1 year and 14–17% at 2 years, with a higher hepatic venous pressure gradient (HVPG) being a main risk factor for variceal development 1.
• Spontaneous bacterial peritonitis (SBP) is a common life-threatening complication in cirrhosis, with a high prevalence of multidrug-resistant pathogens, particularly in nosocomial infections 1.
• The use of vasoactive drugs and intravenous albumin is crucial in the management of variceal hemorrhage, ascites, and hepatorenal syndrome in cirrhosis patients 1.
• Regular screening and prompt management of these complications are essential parts of cirrhosis care to improve morbidity, mortality, and quality of life.

Overall, prompt recognition and management of these life-threatening complications are critical to improving outcomes in cirrhosis patients.

From the Research

Life-Threatening Conditions in Cirrhosis Patients

Cirrhosis patients are at risk for several life-threatening conditions, including:

• Ascites: a complication of cirrhosis characterized by the accumulation of fluid in the peritoneal cavity 2
• Spontaneous bacterial peritonitis (SBP): a bacterial infection of the ascitic fluid that can occur in patients with cirrhosis 2, 3
• Hepatic encephalopathy: a neurological disorder caused by liver dysfunction 2, 4, 5
• Portal hypertension: a condition characterized by increased pressure in the portal vein, which can lead to variceal bleeding and other complications 2, 4, 5
• Variceal bleeding: a life-threatening complication of portal hypertension that can occur in patients with cirrhosis 2, 4, 5
• Hepatorenal syndrome: a type of kidney dysfunction that can occur in patients with cirrhosis 2, 3

Infections in Cirrhosis Patients

Cirrhosis patients are also at increased risk of developing bacterial infections, including:

• Urinary tract infections 3
• Pneumonia 6
• Meningitis 6
• Tuberculosis 6
• Liver abscess 6
• Bacteremia 6

Management and Prevention

Management and prevention of these life-threatening conditions include:

• Sodium restriction and diuretics to manage ascites 2
• Antibiotic prophylaxis to prevent SBP and other infections 2, 3, 6
• Endoscopic banding and sclerotherapy to manage variceal bleeding 2, 4
• Transjugular intrahepatic portosystemic shunt (TIPS) to reduce portal hypertension and prevent variceal bleeding 2, 5
• Liver transplantation in patients with advanced cirrhosis 2, 3, 5